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People with kidney failure will often need to take many drugs to help keep them healthy. This page lists some of the drugs that are commonly taken and a few side effects.

STOP DIALYSIS ACCESS BLOCKING

Aspirin are known as antiplatelet tablets. These are given to help thin your blood and is usually given for patients with heart problems. If you are a dialysis patient, aspirin may also be given to stop your dialysis access becoming blocked. It is normally taken once a day in the morning. Aspirin may irritate your stomach or cause indigestion (heart burn). This can be reduced by taking the tablet with food and dissolving it in water before swallowing. Blood thinners can cause bruising, which is usually normal. However, if you notice excess bruising or blood when you go to toilet or when you cough, please contact a healthcare professional as this could mean your blood is too thin.

In some cases, you may be given a similar antiplatelet tablet, such as clopidogrel or dipyridamole.

STOP ITCHING

Itching can occur in kidney failure because of toxins building up in your body. There are a few treatments that may help with itching, which you can discuss with your kidney team.

Creams and ointments: Keeping your skin moisturised and cool can help with itching. Creams that often contain cooling ingredients, such as menthol, can work for some patients.

Gabapentin and pregabalin: These medication work by affecting your nerve endings in your skin. This can help to stop itching. These medications can make you feel tired and drowsy. If you feel drowsy, do not drive or operate machinery.

Anti-depressants: Some antidepressants may work for itching, but they take a while to have their effect. These medications can make you feel tired and drowsy. If you feel drowsy, do not drive or operate machinery.

Antihistamines: Chlorphenamine belongs to a group of medicines called antihistamines. They are sometimes used to reduce itching in kidney failure, however they are not usually effective. Some antihistamines can cause drowsiness. If you feel drowsy, do not drive or operate machinery. A lot of antihistamines can be bought from your local pharmacy if you feel they help.

Difelikefalin: This medication is only suitable for patients on dialysis and is injected into the dialysis machine, three time a week. This medication can make you feel tired and drowsy. If you feel drowsy, do not drive or operate machinery. You may also notice numbness or tingling in your hands, feet and mouth or dizziness.

Phosphate binders: high levels of phosphate in the blood can lead to itching. We can reduce the levels of phosphate in the blood by using medication called phosphate binders. See the “TREATMENT FOR BONE DISEASE: STENGTHENING YOUR BONES” section for more information on lowering your phosphate levels.

STOMACH PROTECTION

Lansoprazole and Omeprazole reduce the amount of acid in your stomach. They can help with indigestion (heart burn) or problems with stomach ulcers. Lansoprazole should be taken first thing in the morning, before breakfast. Omeprazole can be taken in the morning or in the evening. Side effects include diarrhoea and feeling sick.

REDUCE CHOLESTEROL IN THE BLOOD

Simvastatin, pravastatin or atorvastatin help to reduce cholesterol levels. Simvastatin and pravastatin should be taken at bedtime, but atorvastatin can be taken any time of day. Possible side effects include headache, feeling sick, muscle pain. If you notice any muscle pain, you should talk to your doctor or pharmacist.

RELIEVE CONSTIPATION

Lactulose, macrogols (laxido or movicol), docusate and senna are laxatives and are given to treat constipation. They may take a day or so to be effective and should be taken regularly for a few days to have their effect. Side effects can include belching, bloating and stomach cramps.

SLOWING KIDNEY DIEASE

SGLT2 inhibitors (also known as “flozins”), such as dapagliflozin (or other drugs ending in -flozin), along with a drug called finerenone may be used to try and slow down the decline in your kidney function. Your kidney doctor will discuss with you whether you need to be on this medication.

Flozins are a once a day tablet, taking in the morning. These medications are especially important in those patients who have diabetes, but also may be used in patients who don’t have diabetes. These medications can affect your blood sugars, so If you are diabetic we may need to change your diabetic medication.

Finerenone is a once a day tablet, taken in the morning. This medication is especially important in those patients who have diabetes. Finerenone can affect the potassium levels in your blood. This will mean that we need to monitor your potassium levels when your start treatment.

REPLACING VITAMINS

Dialysis patients are more likely to have low levels of vitamins that get removed with the water during dialysis. If you are on dialysis, we may need to replace these vitamins with a combination tablet, such as Ketovite, Dalavit or Renavit.

REMOVE ACID IN THE BLOOD

People with kidney failure can have high acid levels in their blood, as it cannot be removed properly by the kidney. Sodium bicarbonate are capsules which are taken to make your blood less acidic and also balance out potassium levels. They are usually taken two or three times a day and the dose is altered based on your blood results. This medication can make people feel sick, as well as causing stomach cramps, belching and flatulence.

TREATMENTS FOR ANAEMIA: INCREASING YOUR BLOOD COUNT

People with kidney failure can suffer from anaemia, which can make you feel breathless, cold, tired and sometimes makes you not be able to concentrate. This is because there are a lower number of red cells in the blood, which carry oxygen around your body. If there are less cells carrying around oxygen, this can lead to that feeling of being breathless and tired.
You will be measured how your red cells are working by looking at a blood test called “haemoglobin”. Patients with anaemia often have a low haemoglobin.
There are two ways of treating anaemia and increasing your haemoglobin:
• giving iron treatment, which will make sure your red blood cells work properly.
• Giving erythropoiesis stimulating agent (ESA) injections or HIF stabiliser tablets (see further information below on these drugs). These drugs will increase the amount of red blood cells in your body.

IRON TREATMENT

IRON TABLETS

Iron tablets can be used to treat anaemia, however they are less useful in patients with severe kidney disease, so normally intravenous iron infusions are preferred. The tablets are often taken three times a day, ideally on an empty stomach. If you are taking phosphate binders or some antibiotics (check with the pharmacist) you should try and wait for an hour after taking your iron tablet as they can interfere with each other. Side effects can include constipation, diarrhoea or feeling sick – If this happens try taking the tablets with food. You may notice your stools or urine becoming a darker colour; this is normal and nothing to worry about. If your stools suddenly become very black, tell your doctor.

INTRAVENOUS IRON INFUSION

Intravenous iron can be used for people who are anaemic and either cannot take iron tablets, find the tablets aren’t working or in those people who need a large iron boost.

You will need to be brought into an infusion unit to have your infusion given by a nurse. If you have been told that you still require oral iron tablets, these will need to be stopped the day before your infusion and restarted 5 days after you have been given the infusion.

You should not receive any intravenous iron if you have previously had a severe allergic reaction to iron or if you have an infection which you are either about to get antibiotics for, or are currently on antibiotics for.

For some types of intravenous iron, your first dose will be given very slowly and gradually increased to make sure you don’t experience an allergic reaction, however allergic reactions to iron are rare. Other side effects during the infusion include: headache, nausea, metallic taste in your mouth, fever and skin flushing. These effects are not an allergic reaction, but if you experience these effects, it may mean that you need to be given the infusion over a slower time.

ERYTHROPOIESIS STIMULATING AGENTS (ESA)

One of the jobs the kidneys do is make the red blood cells, which carry the oxygen around your body. To do this they make a chemical called erythropoietin (EPO). When someone’s kidneys do not work, the kidneys produce less EPO and so the person becomes anaemic.
Injectable erythropiesis stimulating agents (ESA) are medications similar to the erythropoietin chemical. They work by increasing the number of red blood cells in the body. A lot of patients with kidney failure are on this drug to treat their anaemia.

There are several different brands of the drug, these include :
• Eprex
• Neo-Recormon
• Retacrit
• Aranesp
• Mircera

It does not matter which brand you receive, but you should always stick to the same brand unless told otherwise. Each of the brands are available as different preparations for example, pre-filled pens or syringes. Your doctor, specialist nurse or pharmacist can help you to decide which sort suits you best.

ESA’s need to be given by injection through the skin or through the dialysis machine. You will be taught how to inject yourself with ESA.
The dose of medication changes from person to person, but kidney team will look at the level of haemoglobin in the blood to decide which dose to use. It is usual to inject a dose once, twice or three times a week. Once stable, you may find you only need to inject every two weeks (or every month if you are not on dialysis).

ESA’s may cause your blood pressure to rise, especially at the beginning of treatment. It is important that your blood pressure is monitored closely until you are on a stable dose of medication.

You will also be closely monitored your haemoglobin to know that the medication is working properly.

Other side effects are injection site pain or redness around the injection site, these can be reduced by changing the site you inject your medication.

HYPOXIA-INDUCIBLE FACTOR (HIF) STABILISERS

HIF stabilisers are oral medication, which work in a similar way to ESA injections. They work by increasing the levels of EPO in the body. This then causes an increase in red blood cell levels in the body, meaning more oxygen can be moved around the body. This will reduce the symptoms of anaemia, such as tiredness and breathlessness.

These medications are mostly suitable for those patients who are not on dialysis. However, they may be used in dialysis patients in certain cases.

The dose of medication changes from person to person, but kidney team will look at the level of haemoglobin in the blood to decide which dose to use.

HIF stabilisers may cause your blood pressure to rise, especially at the beginning of treatment. It is important that your blood pressure is monitored closely until you are on a stable dose of medication. We will also closely monitor your haemoglobin to know that the medication is working properly.

Other side effects include: headache, feeling sick and constipation, high potassium levels in your blood and swelling.

TREATMENT FOR BONE DISEASE: STENGTHENING YOUR BONES

Kidneys have a role in keeping your bones strong. Patients with kidney failure often aren’t able to process vitamin D, calcium and phosphate in the correct way, which are involved in keeping the bones strong. Often, patients need to take vitamin D supplements and have to take medication to lower the phosphate levels in the blood. If this is not done then bones can become weak, which can lead to breaks and fractures.

PHOSPHATE BINDERS

Phosphate is a mineral that affects the health of bones. When someone has kidney failure they tend to have high phosphate levels. This puts them at risk of bone problems. Too much phosphate in your body can also make you itchy. Long-term, high levels can also affect the health of blood vessels and the heart.

Treatment includes eating a diet low in phosphate and taking phosphate binders. Dialysis treatment also helps to remove some phosphate.

There are several types of phosphate binders available. Your kidney team will help to decide which one is best, based on blood results and how easy you find it to take your tablets.

• Calcichew is a phosphate binder which contains calcium. Side effects include a chalky taste in the mouth, or sometimes the level of calcium in your blood can rise. Calcichew tablets should be chewed or sucked, 10-15 minutes before meals.
• Phosex/Renacet (calcium acetate) are phosphate binders which contain calcium. They should be swallowed whole and taken just before meals.
• Osvaren (calcium acetate and magnesium carbonate) are phosphate binders which contain calcium. They should be swallowed whole and taken just before meals.
• Renagel/Renvela (sevelamer) are phosphate binders which do not contain calcium. The tablets should be swallowed whole with meals. Renvela is also available as a powder to make into a solution.
• Fosrenol (lanthanum) is a phosphate binder which doesn’t contain calcium. The tablets should be chewed and taken immediately after meals. Powder is also available, which can be sprinkled on food and mixed in before eating. Side effects include feeling sick if taken on an empty stomach
• Velphoro (sucroferric oxyhydroxide) is a phosphate binder which contains iron. It should be chewed and not swallowed whole. Tablets can also be crushed. They are taken just before meals. These tablets can make your stools dark in colour. This is normal.

Reducing the amount of phosphate in your body can only be done in combination with controlling your diet, these tablets will not work alone. Your kidney dietician will be able to give you advice on lowering your phosphate levels in your diet.

Phosphate binders only work if taken with foods containing phosphate. They should be taken with meals or snacks which include meat, fish, eggs, cheese, milk and pulses.

They should NOT be taken with meals or snacks which do not include protein foods. So, they do not need to be taken with foods such as toast, jam or salad sandwiches, biscuits or fruit. This may mean that you take more binders with a main meal or include one with a snack. Your dose will be altered by your kidney team based on your current diet.

The most common side effects with these tablets are constipation or diarrhoea, feeling sick and a chalky taste in your mouth.

VITAMIN D TABLETS

Alfacalcidol is a Vitamin D capsule. It is given to increase your blood calcium level and keep it normal. Over time this helps to keep your bones healthy.

It is usually taken once a day in the morning or three times a week with each haemodialysis session, but the dose can change based on your blood results. Side effects can include feeling sick. If this happens, try taking it with food. Liquid drops are also available if you have trouble swallowing, or prefer to avoid capsules that contain gelatin, for example, if you are a vegetarian.

SICK DAY GUIDANCE WHEN YOU ARE UNWELL WITH:

1) Vomiting or diarrhoea
2) Fevers, sweats or shaking
You should temporarily stop taking the following medications to reduce your chance of being admitted to hospital:
• Diuretics – bendroflumethiazide, furosemide, indapamide, spironolactone and finerenone
• ACE Inhibitors – medicine names ending in “pril” e.g. lisinopril, perindopril, ramipril
• Angiotensin receptor blockers – medicine names ending in “sartan” e.g. candesartan, losartan, valsartan
• Metformin – a medication used for diabetes
• SGLT2 inhibitors (“Flozins”) – dapagliflozin, empagliflozin, canagliflozin
You should restart any of the above medications that you have stopped when you are well. This is after 24-48 hours of eating and drinking normally. If you are unsure of whether to stop a medication, please contact your pharmacist, GP or specialist nurse.

STORING YOUR MEDICINE

Store the tablets in their original packet in a cool, dry place out of the sight and reach of children. Only remove the tablets from the container when it is time to take them.
Do not throw out any expired or unwanted medicine by flushing them down the toilet or throwing them away. Take them to your local pharmacy which will dispose of them for you.

Written by Gareth Bryant, Specialist Pharmacist for Nephrology and Transplant, Cardiff and Vale University Health Board.
July 2023
Next review July 2026

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The National Kidney Federation cannot accept responsibility for the information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.